| Objective: imatinib is a common preoperative adjuvant therapy for gastrointestinal stromal tumors(GIST).It has been widely used in clinic and has a significant response on improving the survival rate of patients.Through the analysis of histological response,this study analyzed the relationship between histological response and prognosis and the related factors affecting histological response,and discussed the related factors affecting the prognosis of GIST imatinib after targeted therapy,in order to form a deep understanding of preoperative targeted therapy of GIST,so as to guide patients with individualized treatment after operation.Methods: The clinicopathological data of 42 patients with gastrointestinal stromal tumors who received preoperative imatinib adjuvant therapy and surgical treatment in our hospital from June 2011 to November 2016 were analyzed retrospectively,and evaluated according to the CHOI evaluation criteria to evaluate whether they can be resected or not.The proportion of necrotic and degenerative areas of GIST in the tumor was regarded as the histological response(HR)of preoperative targeted therapy of GIST imatinib.The correlation between histological response and survival status was analyzed by binary Probit regression.According to the histological efficacy evaluation criteria of Chinese consensus on diagnosis and treatment of Gastrointestinal Stromal tumors(2017 Edition),histological responses were divided into four grades.Kaplan-Meier method was used to compare the relationship between the existing histological efficacy evaluation criteria and the overall survival time of patients.Log-rank test was used to test the difference in the distribution of total survival time between the total survival time and each grade,to analyze the relationship between the grade and prognosis,and to evaluate whether it is suitable for evaluating the curative response after preoperative imatinib adjuvant therapy and guiding the individualized treatment of patients after operation.The best cut-off value of histological response was obtained by ROC curve,and the histological response was re-grouped.Kaplan-Meier method and Log-rank test were used to analyze the relationship between histological response and survival and prognosis.Chi-square test was used to analyze the correlation between histological responses and other clinicopathological factors.Finally,univariate and multivariate analysis was conducted with COX regression model to explore the prognostic factors of preoperative adjuvant therapy for GIST imatinib.Results: There was a correlation between the histological response and the survival state of the patients(P =0.005 < 0.01).In the process of analyzing the survival and prognosis of the existing curative response evaluation criteria,it was found that the difference in the distribution of survival time between HR1 and HR4 was statistically significant,and the overall survival rate of HR4 was significantly higher than that of HR1(P < 0.001).However,the differences in the distribution of survival time among the other groups(HR1 and HR2,HR1 and HR3,HR2 and HR3,HR2 and HR4,HR3 and HR4)were not statistically significant,indicating that there was a prognostic difference between mild responses and high responses,and the prognosis of high responses was significantly better than that of mild responses,but could not be distinguished from those of low responses and moderate responses(accounting for 45% of the total).The existing histological evaluation criteria are not suitable for evaluating the efficacy of preoperative imatinib adjuvant therapy and guiding the individualized treatment of patients after operation,especially for patients with low and moderate responses.The best cut-off value of histological response(20%)was obtained by ROC curve,and the histological responses were re-grouped(low histological response ≤ 20%,high histological response >20%).Using Kaplan-Meier method and Log-rank test,it was found that patients with high histological response group(HR > 20%)had significantly longer overall survival than those with low histological response(HR ≤ 20%).(P < 0.001).With 20% as the critical value,the survival prognosis of histological responses after preoperative imatinib adjuvant therapy in patients with GIST can be distinguished.Through chi-square test,it was found that there were significant differences in Ki67 among different histological responses(> 20%,≤ 20%).Histological response was related to mitotic image and Ki67 positive index.By COX regression univariate analysis,it was found that tumor size,mitotic image,Ki67 positive index and histological response were all correlated with the overall survival time(OS)of patients with GIST after preoperative imatinib adjuvant therapy(P< 0.001).The results of univariate analysis showed that tumor size,mitotic image,Ki67 positive index and histological response were all correlated with postoperative overall survival time of patients with imatinib adjuvant therapy before operation.Using COX regression model for multivariate analysis,it was found that histological response was an independent predictor of prognosis in patients with GIST.Conclusion: 1.Histological response is an independent predictor of prognosis for GIST patients who received preoperative imatinib targeted therapy.It is of great significance to evaluate the histological response after operation.2.The existing histological evaluation criteria may not be suitable for predicting the prognosis of GIST patients who received preoperative imatinib adjuvant therapy,especially for patients with low and moderate responses.3.The histological response of 20% as the critical value can distinguish the curative response of preoperative imatinib adjuvant therapy and can be used to predict its prognosis,which is of great significance to guide the postoperative individualized treatment of this kind of patients who received preoperative imatinib adjuvant therapy.4.Mitotic image,Ki67 positive index and histological response have a certain relationship,may indirectly affect the prognosis of patients,and have important reference value in predicting the prognosis of GIST patients treated with imatinib before operation. |
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